Inspection on 11/08/09 for Grey Gables

This inspection was carried out on 11th August 2009.

CQC found this care home to be providing an Poor service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Grey Gables 17/09/08

Grey Gables 01/11/07

Grey Gables 03/05/07

Grey Gables 23/11/06

Grey Gables 03/05/06

Grey Gables 09/12/05

Grey Gables 07/06/05

Grey Gables 05/10/04

Grey Gables 29/06/04

Grey Gables 26/01/04

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Grey Gables 39 Fox Hollies Road Acocks Green Birmingham West Midlands B27 7TH Lead Inspector Brenda O’Neill Key Unannounced Inspection 11th August 2009 09:00 DS0000016772.V377115.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Grey Gables DS0000016772.V377115.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Grey Gables DS0000016772.V377115.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grey Gables Address 39 Fox Hollies Road Acocks Green Birmingham West Midlands B27 7TH 0121 706 1684 0121 706 2025 reception@greygables.org.uk www.greygables.org.uk Grey Gables Committee Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Annemarie Hosty Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Grey Gables DS0000016772.V377115.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP) 40 The maximum number of service users who can be accommodated is: 40 17th September 2008 Date of last inspection Brief Description of the Service: Grey Gables is a care home, which is registered to accommodate up to 40 elderly people. It is close to public transport links. It is set in a large, extended property. The home is owned and run by an unincorporated registered charity, Grey Gables Trust, and representatives of the committee visit the home regularly. The home has a selection of sitting rooms and dining rooms and although the people living at the home may choose where they spend their time, they are grouped in units according to their level of dependency. The home had one double bedroom and the rest are single rooms, the vast majority have en suite facilities. The home has ample assisted bathing facilities including one assisted shower. There are parking spaces at the front of the building and to the rear is a large, accessible and well-maintained garden. The homes main entrance has steps but there is a separate access point for people with mobility difficulties. The home has two passenger lifts that ensure all areas of the home are accessible. The most recent inspection report was on display in the home. The range of fees charged at the home were detailed as between £350:00 to £475:00 per week in the service user guide. Items not included in the charges Grey Gables DS0000016772.V377115.R01.S.doc Version 5.2 Page 5 include dry cleaning, hair dressing and telephone calls. Grey Gables DS0000016772.V377115.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means that the people who use this service experience poor outcomes. This inspection was carried out over one and half days by two inspectors. The home did not know we were going to visit. The focus of inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection. This included notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law, and an Annual Quality Assurance Assessment (AQAA). This is a document that provides information about the home and how they think that it meets the needs of people living there. Four of the people living in the home were ‘case tracked’ this involves establishing individual’s experiences of living in the care home by meeting them, observing the care they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked around some areas of the home and a sample of care, staff and health and safety records were looked at. During the course of the inspection we spoke with six of the people living in the home, one visitor, the manager and six staff to get their views on the home. We sent twelve ‘Have Your Say’ surveys to the people living in the home and eight staff members. A total of eight were returned, six from people living in the home and two from staff. These views have been included in the report. What the service does well: We received some very positive comments about the home including: ‘Try their best to look after every body’ ‘Happy as it is.’ Grey Gables DS0000016772.V377115.R01.S.doc Version 5.2 Page 7 ‘Provide correct level of care.’ ‘Looks after me.’ ‘Care staff are caring with me.’ People have access to a range of healthcare professionals to ensure that all their health care needs are met. There was a good range of activities available so people did not become bored and were able to lead fulfilling lives. The home has an open visiting policy so that people can see their visitors as they choose and can continue to maintain relationships that are important to them. People were offered a choice of meals which met their individual dietary needs and preferences. The people living in the home were listened to and their views acted on. People could personalise their own rooms to reflect preferences and tastes. Maintenance checks were completed to ensure equipment was in safe and working order. What has improved since the last inspection? What they could do better: Care plans should reflect the current needs of the people living in the home to ensure they receive person centred care on an ongoing basis. Grey Gables DS0000016772.V377115.R01.S.doc Version 5.2 Page 8 Risk management plans must be in place to ensure staff have all the information they need to keep the people living in the home safe. Staff must put into practice the training they have had to ensure people are cared for safely and with respect at all times. Improvements are needed to the management of medication to ensure people receive their medication safely and as prescribed. Staffing levels should ensure the people living in the home are safe at all times.. There should be a system in place to show how the home is to be improved for the benefit of the people living there. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Grey Gables DS0000016772.V377115.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Grey Gables DS0000016772.V377115.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was information available for people to help them decide if the home was the right place for them. People could not be confident that their needs would be fully assessed before moving into the home and this could lead to people not getting the care they need upon admission to the home. EVIDENCE: There was service user guide available at the home that told people what they can expect from the service. This had been updated and was available in large print for those people with impaired sight. The document included the range of fees charged at the home. However it stated the charges were dependent on the care package received. This was discussed with the manager and this was not the case. The fees were dependent on the type of accommodation people wanted. This should be clarified so that people know exactly what they are Grey Gables DS0000016772.V377115.R01.S.doc Version 5.2 Page 11 paying for. One relative that was spoken with said she thought people got ‘very good value for money’ at the home. Six of the seven surveys returned to us before the inspection indicated that people had received enough information to help them decide if the home was the right place for them. All the people spoken with during the inspection were very satisfied with the service they were receiving at the home. The pre admission process was looked at for two people. One of these people was privately funded. The staff at the home had assessed the individual before admission however the assessment was not dated and did not indicate where it had been undertaken. This should be included so that it can be shown people have their needs assessed before being admitted to the home. The assessment document included most areas of the individual’s life and gave some indication of where she needed help and what she was able to do herself. The assessment did not include any summary or say how the decision had been made that the home could meet the persons’ needs. The individual was spoken with and she was very satisfied that her needs were being met. The procedure was looked at for another person who had been asked to leave the home as the staff could not meet his needs. The home had undertaken their own assessment but this did not indicate that there would be any issues meeting the individuals’ needs. A social worker had been involved in the admission. At the time of the inspection the copy of the social worker’s assessment and the initial care plan drawn up but them could not be found. We were told these had been files away. When these were found the manager told us the assessment did not give the full details of the individual’s needs. We were also told that the social worker had been contacted about this and that she had apologised for the omissions. The home does not offer intermediate care. Grey Gables DS0000016772.V377115.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff do not always have enough or current information so that they can meet peoples’ personal and healthcare needs. Some staff practice could leave people at risk of harm. EVIDENCE: People living in the home had care plans in place. These are an individualised plan about what the person is able to do independently and states what support is required from staff in order for the person to meet their needs. We looked at four peoples’ care files in detail. All files sampled included a profile of the individual which gave some detail of the person’s history, family and some general information about them. Care plans were divided into various sections for such things as personal care, mobility, activities and eating and drinking. Some of the care plans did give Grey Gables DS0000016772.V377115.R01.S.doc Version 5.2 Page 13 some basic information about peoples’ likes and dislikes in relation to food and activities but there was little else that was individualised to the specific people. Some of the areas in the care plans were the same for all four people in particular personal care. Included in this section were statements such as ‘ensure she is getting the assistance needed concerning her personal care’. This is not adequate information for staff to be able to meet peoples’ needs particularly if they were not able to tell staff how they wanted their care delivered. For example, one of the people whose care plan was sampled had dementia. Staff told us she was unable to tend to her own personal care needs at all and they did everything for her. Her care plan did not give any details about her needs in relation to oral care, hair care or nail care. Records indicated she was having her hair done by the hairdresser and staff were doing her nails. However when asked about oral care and if she has her own teeth or dentures one said ‘own teeth but can’t get in her mouth’ another said ‘not own teeth don’t think she has dentures.’ It was confirmed by a senior staff member she has no teeth. This lack of knowledge of staff and detail in care plans could lead to people not having their oral health care needs met. One person’s care plan did give some details of how to communicate effectively with him due to a hearing impairment and that if he could not hear to write things down for him. However for another person who was not able to communicate verbally the care plan did not give staff any details of how they were to try and do this. When staff were asked about the person’s communication needs and how they enabled this person to make choices we received a variety of answers. For example, ‘she cannot make choices we do that for her’ and others said we know when she does not want something by her facial expression. The lack of detail in the care plan in relation to this means this person was not being enabled to make choices for herself on an ongoing basis. One person’s care plan indicated he was mobile with a zimmer frame but discussions with staff, observations made and records sampled showed that this person was no longer mobile. He had recently returned from hospital and staff were using the hoist for all transfers. Staff spoken with were aware of the changes in his condition and told us he could not walk. When asked what equipment was being used for transfers staff were consistent about the hoist they were using but not the sling size. One person said ‘sling size will be in care plan’ another said ‘mini hoist green sling try it on if it fits perfect around the waist and legs that one’ and another said ‘blue sling, bit big need a smaller one.’ The correct sling size was not in the care plan as this had not been updated to reflect the changes. These inconsistencies are dangerous and mean people were not being moved safely. There were risk assessments on peoples’ files for manual handling, tissue viability, nutrition and some general risks. These varied in the detail included and most did not give staff adequate detail to ensure peoples’ risks were minimised. For example one person had a management plan in place for what Grey Gables DS0000016772.V377115.R01.S.doc Version 5.2 Page 14 was described as challenging behaviour at night. This gave some detail of how staff were to manage the behaviour by 1 to 1 supervision but it did not say what to do about any verbal aggression. Day staff told us this person could be difficult during the evening but they had not been given any guidance as to how to manage his behaviour. One person said ‘just have to deal with it’ another said ‘I tend to back off other people do handle it differently.’ Staff need to be consistent so the individual knows what is and what is not acceptable and to ensure that neither he or staff are put at risk because of inappropriate management. Staff were able to give examples of what had been tried to do to try and ease the situation, for example, evening baths and walks. These had had little effect. Staff told us another person in the home could be difficult to manage when trying to tend to their personal care needs as she was very stiff and could become agitated. Her care plan stated ‘can become breathless when agitated staff to reassure her’ but there was no detail of when or why she may become agitated or what staff were do about it. Staff were just managing her behaviour as they saw fit. This is not appropriate and could mean she is not having her needs met in a suitable manner. The lack of detail on peoples’ risk assessments and tissue viability assessments could put people at risk of developing pressure sores. For example, one persons’ risk assessment stated that she may be at risk as she does not move without assistance. It indicated that if the tissue viability assessment score was high staff were to observe for pressure sores. The score was very high but there was no written guidance of any preventative measures that were in place to avoid pressure sores. When staff were asked they said she sat on a pressure cushion this was not observed during the inspection. This person was at risk of developing pressure sores. Some unsafe practices were observed during the course of the inspection. One person’s manual handling risk assessments stated two staff were to assist her walk. This was not happening staff were seen to lead this person by holding both her hands and staff walking backwards. Another person was seen to lift one person back in their chair by hooking them under their arms and lifting backwards. Both are unsafe practices and could result in the people living in the home and the staff being injured. There was ample evidence on the records sampled that people had access to medical professionals as needed. Records showed people had visits from G.P.s, district nurses, chiropodists, opticians and continence advisors. Where one person had been having an excessive amount of falls a lot of advice and medical input had been sought to try and manage the situation. The person had been referred to the falls clinic and had been seeing a physiotherapist. Crash mats and alarms had been installed in the person’s bedroom so that staff knew when he was up and about, a referral had also been made for Grey Gables DS0000016772.V377115.R01.S.doc Version 5.2 Page 15 protective equipment for the person to wear and the home were waiting for this to be delivered. People were being weighed on a regular basis. One person’s records showed us that staff had recognised the person had been losing weight and had referred him to the GP who had prescribed some dietary supplements which were being given. For another person the records indicated there had been some significant weight loss over one month. There were no records to indicate this has been followed up. Staff were asked what the procedure was for weighing people and passing on information. We were told people were all weighed around the same time and that senior staff would instigate the task. However there was no set procedure for reporting weight loss or gain. This was discussed with the manager as it was not a robust and weight loss could signify underlying health concerns. Six surveys were returned to us from the people living in the home and they all indicated that people felt the home made sure they got the medical care they needed. All the comments received about the service were generally quite positive these included: ‘Try their best to look after every body’ ‘Happy as it is.’ ‘Provide correct level of care.’ ‘Looks after me.’ ‘I cannot be rushed and I wish the carers would be easier on me.’ ‘More time to talk to carers about individual minor needs e.g. having ears syringed.’ One question asks what does the home do well and people commented: ‘Everything.’ ‘Medical needs/contact doctor, care staff are caring with me.’ The daily records and the appearance of the people living in the home showed that people were having their personal care needs met. People were seen to be dressed appropriately in styles that reflected their age, gender and personal choices. The management of medication was reviewed and was generally well managed. There were audit trails for all medication. People could choose to manage their own medication if they wished and they were assessed as able to do this safely. Records were sampled. Some minor discrepancies were found in the amounts of tablets received what had been administered and what was remaining in the home. One lot of medication had too many tablets remaining and as the person was to have two tablets daily this could mean they had not been having their full dosage. This could affect this person’s well being. Grey Gables DS0000016772.V377115.R01.S.doc Version 5.2 Page 16 The records for the receipt and administration for controlled medication had improved and showed that staff followed correct procedures to ensure it was administered safely. There were several homely remedies in the home. There was an audit trail for these but it was difficult to follow as all the medicines were in one book. The manager needed to ensure that all the appropriate G.P.s were consulted about what homely remedies people could be given to ensure people were not given anything that may have an adverse affect on them. There was some written guidance for staff in relation to ensuring people were not given paracetamol based medicines if they were already on this as it could cause them harm. The people living in the home were generally treated with respect and their rights to privacy upheld. On the whole staff were very polite and interacted well with the people living in the home. There were two occasions when the interactions we observed showed little respect for the people living in the home. One person who was hard of hearing was shouted at across the dining table by a staff member in quite an aggressive manner although they were only asking if they had eaten enough. Another person who was sat with their eyes closed had their chair pulled away from the table very abruptly by staff without them being spoken to or alerted in any way. This person was visibly startled by this and could have reacted to the staff member in an adverse way. Assistance with personal care and eating was offered discreetly. One person was seen to quite upset during the inspection and a staff member immediately went to her to offer some comfort and reassurance. Individuals could spend time in their bedrooms without being disturbed if they wished. There were keys available for the people living in the home so they could lock their bedroom doors and there was a section on their files stating they had been asked about this. Grey Gables DS0000016772.V377115.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a choice of activities so that they experience a meaningful lifestyle. People are offered a choice of meals which meet individual dietary needs or preferences. EVIDENCE: The home had a relaxed atmosphere throughout the inspection. One person told us ‘there are no rules’ and ‘no specific times for going to bed.’ People were seen to move freely around the home, some were having their hair done, some were watching television, others were knitting and some were chatting in small groups. All the people seen during this inspection were content and told us they were happy with the service they received. The activities programme in the home showed there was a good range of activities on offer so that people were offered some stimulation. These included, shows, church services, arts and crafts, famous faces quiz, music and exercise, motivation and musical bingo. Many of the activities were facilitated by visitors to the home. Photographs around the home showed Grey Gables DS0000016772.V377115.R01.S.doc Version 5.2 Page 18 people taking part in other activities such as parties and people holding small animals that had been brought into the home by an outside organisation and everyone seemed to be enjoying this. Surveys returned to us indicated the home arranges activities people can take part in if they wish. Relatives feed back given to the home indicated that activities were good or adequate. Comments included: ‘Seem to have improved.’ ‘More activities and more variety would be welcome.’ Minutes of meetings with the people living in the home showed activities were discussed with them to get their views and to inform people of what had been arranged. The minutes detailed such things as activity sheets showing what was on offer in the coming month being put in bedrooms so that people would know what was available. These were seen in bedrooms. Also people had been informed that further activity equipment had been purchased. People were able to keep in touch with people that were important to them. Records showed people had visitors at varying times of day. Some people had telephones in their rooms so they could keep in touch with their relatives. Visitors were seen to come and go as they wanted. One visitor was spoken with and was very satisfied with the home and was made welcome. People were able to go out with friends and relatives if they wished. This was shown in daily records and one person told us a relative was taking him out next week. In the main the people living in the home were able to exercise choice and control over their lives in such things as choosing what they did during the day, what to wear, when to get up and go to bed and what to eat. Also where people were able they could self manage their medicines. Daily records showed that if people did not want to take part in activities their wishes were respected. The home had a rotating menu that was varied and nutritious. Although there were no stated choices on the menu there was a list of alternatives that were available all the time if anyone did not want the main course of the day. People spoken with said the food at the home was ‘good’. The surveys returned to us indicated that people either always liked the meals or usually liked them. We saw the food served on the first day of the inspection and it looked very appetising and was well presented. As stated earlier some of the staff practice at lunch time was not very respectful to the people living in the home. However staff were available to assist people with their meal if they needed it and this was done discreetly. Staff knew which people were having specific diets, for example, pureed or diabetic diets which showed specific diets were Grey Gables DS0000016772.V377115.R01.S.doc Version 5.2 Page 19 being catered for. Some people did have to wait quite a long time for their meal and there did not seem a system in place for serving to ensure one table at a time was served. Therefore some people had almost finished their meals before other people at the same table got theirs. The minutes of the meetings held with the people living in the home showed they were consulted about the menu and had made some suggestions as to what they would like included. The suggestions had been included and people were very satisfied with this. Grey Gables DS0000016772.V377115.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples’ lack of knowledge of the complaints procedure could lead to them not having their concerns addressed. There were systems in place to ensure people were safeguarded from abuse. EVIDENCE: The service user guide for the home included the complaints procedure and detailed that people could contact us if they wished however the address and telephone number had not been included. This would make it difficult for people to contact us. The procedure was available in large print for those people with impaired vision. The surveys returned to us indicated that people knew who they could talk to if they wanted to raise any issues but some did not know how to make a formal complaint. This could lead to people not having their concerns addressed. No complaints had been detailed in the home’s complaints register since the last inspection. This is inaccurate as we have referred one complaint back to the home since the last inspection. This was investigated by the responsible individual and the manager and a response was sent to us which was satisfactory. Grey Gables DS0000016772.V377115.R01.S.doc Version 5.2 Page 21 There was evidence in the minutes of the meetings held with the people living in the home that they were listened to and their views acted on. For example, people had mentioned a bush overhanging by a door that was impeding them this had been cut back, menu boards being put up in the dining rooms which were in situ and as previously mentioned suggested changes to the menu had been made. Managers at the home have shown they know when to refer raise safeguarding issues and who with and what part the home have to play in the procedure, for example, suspending staff. Staff had received training in adult protection issues and there were policies and procedures on site referring to this. The staff spoken with had a good awareness of safeguarding issues and the importance of reporting them. They were able to tell us who they would report any issues to other than the manager at the home. This should ensure people are protected from harm. Grey Gables DS0000016772.V377115.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24 and 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with a safe, comfortable and generally well maintained environment in which to live. EVIDENCE: There had been several improvements made in the home including new furnishings, flooring and decoration in some areas, improvements to the main kitchen, stair lifts fitted, shaft lifts refurbished and fencing at the side of the home installed. These improvements ensured the home was generally kept to an acceptable standard, people could move around the home easily and it was secure. Some issues were raised with the manager of the home, for example, one of the units needed new carpet fitted, some areas needed decorating and several Grey Gables DS0000016772.V377115.R01.S.doc Version 5.2 Page 23 beds were seen without head boards. All these areas were being addressed, head boards had been ordered and the new carpet was detailed on the home’s refurbishment plan for the year. It is inevitable in a home of this size that there will be ongoing refurbishment and renewal of furnishings and décor to ensure it is kept to an acceptable standard for the people living there. The home had a lot of communal space which was all well decorated and furnished and was equipped with televisions, DVD players and so on giving people a choice of where they sat and how they spend their day. Bedrooms seen were very comfortable and were personalised to the occupants choosing. People spoken with were satisfied with the environment and were clearly very comfortable. There were a variety of aids and adaptations in the home to help people move around and maintain some independence including hand and grab rails, shaft and stair lifts and emergency call system. There were assisted bathing and showering facilities available for those people who needed assistance form staff. Access to the garden was problematic for the people living in the home with mobility difficulties as the ramped access was quite narrow. However plans had been drawn up to address this and the work was imminent. The home was clean and generally odour free, with the exception of one shower room, and there were appropriate systems in place for the disposal of clinical waste. The surveys returned to us by the people living in the home indicated the home ‘was always clean.’ Grey Gables DS0000016772.V377115.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were being cared for by a well trained, stable staff team but peoples’ needs were not always met safely as training was not always put into practice. Recruitment procedures were robust and safeguarded the people living in the home. EVIDENCE: Rotas indicated that there were six or seven staff available during the day and evening shifts and that there were always senior staff on duty. There were no issues raised by staff in relation to staffing levels and the surveys returned to us indicated there were staff available when people needed them. One person said ‘they are available day and night’. The rotas showed that night staffing levels varied from two to three night care staff. Some time ago the fire officer stated that once the occupancy at the home was over 35 three night staff should be on duty. This was being achieved when none of the night staff were on annual leave. The manager was trying to address this by employing more staff however in the mean time she should liaise with the fire officer to ensure she is not putting people at risk should there be a fire. Following the inspection the manager did contact the fire officer. The response we have received from the home in relation to this states ‘The ratio of staff needed refers to the size of the home’s fire compartments and not to the residents. If the compartment Grey Gables DS0000016772.V377115.R01.S.doc Version 5.2 Page 25 exceeds 7 residents then it requires three members of staff, less than 7 residents only two staff, so we are working well within the fire regulations.’ The AQAA indicated that staff turnover at the home had been relatively low over the past year which is good for the continuity of care of the people living in the home. Staff were described to us as ‘caring’ and people said, ‘They try their best’ ‘Care staff are caring with me.’ One person said ‘it would be nice for the male residents if there were male carers if possible.’ There were eight male people living in the home and no male care staff. It would be beneficial for people to have the choice of having their care delivered by people the same gender as themselves. We looked at four staff files and these contained all the required information to Show that only people suitable to work with the elderly are employed so that people were safe from harm. Twenty three of the twenty eight staff employed at the home had completed a National Vocational Qualification (NVQ) Level 2 in care. This is above the national minimum standards and should ensure that the staff have the knowledge and skills to care for people individually and collectively. The training matrix for the home shows staff have received training in first aid, manual handling, incontinence, medication management, food hygiene and malnutrition this year. Staff confirmed they had had this training and that training was ongoing for them. They felt they received all the training they needed. As cited earlier in this report there were some occasions when staff were not putting their training into practice, for example, manual handling. meaning people were not always cared for safely. Staff told us about their induction training and how they worked through the induction standards booklet over a period of time. Records of these booklets were also seen on staffs’ files. They also told us they shadowed more experienced staff for some time before working on their own. This should ensure staff are equipped with all the skills and knowledge to care for the people living in the home. Grey Gables DS0000016772.V377115.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not always run in the best interests of people as people are not always cared for safely. EVIDENCE: The registered manager has been employed at the home for a considerable amount of time and was appropriately qualified for her role. The home had also employed a deputy manager since the last inspection. Both demonstrated a good knowledge of the needs of the people living in the home. Areas noted for improvement at this inspection included care plans and risk management plans. The issues of poor practice that were observed were Grey Gables DS0000016772.V377115.R01.S.doc Version 5.2 Page 27 discussed with the manager of the home. She was keen to ensure these improved to ensure people were cared for appropriately. There was a quality monitoring system in place that included in house audits against the National Minimum Standards. The difficulty with this was that care plans and risk assessments had been audited and no major deficiencies had been found. This is not a true reflection as, for example, the risk assessments that were sampled were not robust and not all the risks people were exposed to had management plans in place. The system did highlight any actions that needed to be undertaken after the audits with target dates for improvements. Part of the quality monitoring system was sending surveys to relatives and to the people living in the home. Some of the completed surveys were seen and were generally positive. The ones from the people living in the home had indicated they wanted more choice at meal times. This had been followed up in meetings with them and the menus changed. This showed that peoples’ views were acted on. The home did have a yearly improvement plan for the building but not for the general service offered to the people living in the home. The results of all the audits and surveys should be analysed to produce a plan for improving the service over the coming year for the benefit of the people living in the home. As at the last inspection the home did not handle any finances on behalf of the people living there. The manager was satisfied that they got access to as much money as they required. The health and safety of the people living in the home and the staff were generally well managed. Staff had received training in safe working practices. The AQAA indicated that the servicing of the equipment in the home was up to date and the records sampled agreed with this. The in house checks on the fire system were sampled and found to be up to date and regular fire drills were being undertaken to ensure people would be safe in the case of a fire. As stated earlier the manager should liaise with the fire officer in relation to night staffing levels. The reporting of accidents and incidents to us was good so we were able to see that they were being managed in the best interests of the people living in the home. Grey Gables DS0000016772.V377115.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 3 3 2 X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Grey Gables DS0000016772.V377115.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No. Grey Gables DS0000016772.V377115.R01.S.doc Version 5.2 Page 30 STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement Care plans must detail all the current needs of the people living in the home and how they are to be met by staff. This will ensure people receive person centred care. There must be risk management plans in place for all the identified risks for the people living in the home. This will ensure people are safeguarded. Staff must work in line with the Manual handling Regulations and follow any moving and handling plans that are in place. Timescale for action 30/11/09 2. OP7 13(4)(c) 31/10/09 3. OP8 13(4)(c) 30/09/09 4. OP9 13(2) This will ensure the people living in the home are moved safely. The system in place for the 30/09/09 administration of medicines must be robust and ensure people are not having medicines they should not and that the correct dosage is administered at all times. This will ensure people are getting their medicines as prescribed. The home should have a development plan in place. DS0000016772.V377115.R01.S.doc 5. OP33 24 31/10/09 Grey Gables Version 5.2 Page 31 This will ensure the service is improved for the benefit of the people living in the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP1 OP3 Good Practice Recommendations The information in the service user guide should be clarified so that it is clear what people are paying for. The manager should ensure all the relevant information about an individuals needs is obtained before they move into the home. This will ensure an informed decision can be made as to whether they can meet the persons’ needs. There should be a robust system in place for monitoring the weight of the people living in the home. This will ensure any significant weight loss or gain is followed up as this can signify underlying health concerns. Staff should ensure they treat people with respect and consider their feelings at all times. This will ensure people are cared for appropriately. Practice at meal times could be improved to make a more enjoyable experience for the people living in the home. The complaints procedure should include the contact details of the Commission. This will ensure people can contact us if they wish. The refurbishment plan for the home should be followed to ensure the home is kept to an acceptable standard for the people there. The registered manager should liaise with the fire officer to ensure staffing levels are appropriate and do not put people at risk. 3. OP8 4. 5. 6. 7. 8. OP10 OP15 OP16 OP19 OP27 Grey Gables DS0000016772.V377115.R01.S.doc Version 5.2 Page 32 Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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